1993 MHAUS Recommendations

Signs of Malignant Hyperthermia

Tachycardia

Tachypnea

Fever

Rigidity

Metabolic Acidosis

Respiratory Acidosis

Central Venous Desaturation

Central Venous Hypercarbia

Increased End Tidal CO2

Arrhythmias

Cyanosis

Skin Mottling

Masseter Muscle Rigidity

Sweating

Hyperkalemia

Myoglobinemia

Increased CK

Unstable BP

Acute Phase Treatment

1. Stop all triggering agents immediately. Hyperventilate with 100% O2 at >10 L/min. Circle system and absorber need not be changed.

2. Administer Dantrolene. 2-3 mg/kg immediately. Use increments up to 10 mg/kg or more.

3. Correct Metabolic Acidosis. HCO3 1-2 mEq/kg. Follow ABG's

4. Simultaneously with above, actively cool patient. Iced saline 15 ml/kg q 15' X3 IV, lavage body cavities, cooling blanket. Monitor T for overtreatment.

5. Dysrhytmias. Usually respond to treatment of acidosis and hyperkalemia. (Avoid Ca++ channel blockers)

6. Monitor. ETco2, arterial, central or femoral venous blood gases, K+, Ca++, clotting studies, urine output.

7. Hyperkalemia. Treat with hyperventilation, bicarbonate, Glc + insulin (1/2 ml/kg D50 + regular insulin 0.15 u/kg), CaCl2 2-5 mg/kg.

8. Maintain UO >2 ml/kg/hr.

9. Boys < 9 y.o. with cardiac arrest after succinylcholine may have sublinical muscular dystrophy and acute hyperkalemia. Administer CaCl2 along with other means to reduce K..

Post-Acute Phase

1. Observe in ICU at least 24 hrs.

2. Administer Dantrolene 1 mg/kg q6hrs x 24-48 hrs. Oral dantrolene 1 mg/kg may then be used x 24 hrs.

3. Monitor ABG, CK, K, Ca++, urine and serum myoglobin, clotting studies q6hrs until normal. Monitor central T continuously until stable.

4. Counsel. Refer patient to MHAUS (203)847-0407. Fill out Adverse Metabolic Reaction to Anesthesia (AMRA) report available through MH Registry (717)531-6936

MHAUS 24 hr Emergency Hotline (209)634-4917.